Prognosis- A prediction of the probable course, duration, and outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease.
Prognosis is established after diagnosis and before treatment plan.
Types of prognosis:
Excellent prognosis: No bone loss, excellent gingival condition, good patient cooperation, no systemic environmental factors.
Good prognosis: the patient will have one or more of the following: adequate remaining bone support, adequate possibilities to control plaque, adequate patient cooperation, no systemic or environmental factors, and if systemic factors present then well controlled.
Fair prognosis: the patient will have one or more of the following: less than adequate remaining bone support, some tooth mobility, grade I furcation involvement, adequate maintenance possible, acceptable patient cooperation, and presence of limited systemic or environmental factors.
Poor prognosis: the patient will have one or more of the following: moderate to advance bone loss, tooth mobility, grade I or II furcations, difficult to maintain areas, doubtful patient cooperation, and presence of systemic or environmental factors.
Questionable prognosis: the patient will have one or more of the following: advance bone loss, grade II or III furcations, tooth mobility, inaccessible areas, and presence of systemic or environmental factors.
Hopeless prognosis: the patient will have one or more of the following: advance bone loss, non maintainable areas, extractions indicated, and presence of uncontrolled systemic or environmental factors.
Factors in Determination of Prognosis:
Clinical factors include patient age, disease severity, plaque control, and patient compliance.
Prognosis is generally better for older patients because in younger patients the periodontal destruction has occurred in a short time period.
Prognosis is dependent on patients attitude, desire to retain their natural teeth, willingness and ability to maintain good oral hygiene because without patient compliance the treatment may not be successful.
Systemic and environmental factors include smoking, systemic disease, genetic factors, and stress.
Patients with well controlled diabetes with slight and moderate periodontitis have a good prognosis as long as the patient is compliant.
When a patient smokes the prognosis is not as favorable to periodontal therapy. A patient that smokes with slight to moderate periodontitis prognosis is fair to poor. In patients with severe periodontitis the prognosis may be poor to hopeless. Smoking cessation is strongly encouraged in patients with periodontitis to have a more favorable prognosis.
Stress can also have an impact on the prognosis such as physical, emotional, and substance abuse.
Local factors include plaque and calculus, tooth mobility, and subgingival restorations.
Teeth with subgingival restorations can accumulate plaque and may have a poor prognosis compare to teeth with restorations that are supragingival.
Anatomical factors include short roots, cervical enamel projections, enamel pearls, root concavities, developmental grooves, furcation involvement, root proximity and tooth mobility.
Prognosis is poor when the teeth have short tapered roots and relatively large crowns
Prosthetic and restorative factors include caries, nonvital teeth, root resorption, and abutment selection.
Prognosis for Patients with Gingival Diseases:
Gingivitis associated with dental plaque only-
The prognosis is good if local factors contributing to plaque retention are removed and if the patient cooperates by maintaining good oral hygiene.
Plaque induced gingival diseases modified by systemic factors-
Long-term prognosis for these patients depends not only on plaque control, but also on the control or correction of the systemic factors.
Plaque-induced gingival diseases modified by medications-
Long-term prognosis depends on whether the patient’s systemic problem can be controlled by an alternative medication that does not have gingival enlargement as a side-effect. If the gingivitis is caused by oral contraceptives the prognosis depends on the control of plaque as well as the likelihood of continuing the use of the oral contraceptive.
Non-Plaque-Induced gingival lesions-
Prognosis for these patients depends on the elimination of the causative agent or the management of the associated dermatological disorder.
Prognosis for Patients with Periodontitis:
Chronic Periodontitis-
In slight to moderate periodontitis the prognosis is usually good, provided that the inflammation is controlled with good oral hygiene and the elimination of plaque retentive factors. In patients with severe disease, furcation involvement, mobility, and are not compliant with hygiene practices the prognosis may be downgraded to fair or poor.
Aggressive Periodontitis-
If diagnosed early, localized aggressive periodontitis can be treated with oral hygiene instruction and systemic antibiotic therapy resulting in an excellent prognosis. In more advanced cases the prognosis can still be good if treated with debridement, local and systemic antibiotics, and regenerative therapy. In patients with generalized aggressive periodontitis, secondary contributing factors such as cigarette smoking are often present. These factors often do not respond well to treatment and therefore have a fair, poor, or questionable prognosis. The use of systemic antibiotics should be considered to help control the disease.
Periodontitis as a manifestation to systemic disease-
Periodontitis associated with hematologic disorders such as leukemia and acquired neutropenias: the prognosis is often fair to poor due to the alteration of the ability of the host to respond to the microbial challenge.
Periodontitis associated with genetic disorders such as familial and cyclic neutropenia, down syndrome, Papillon-Lefevre syndrome, and hypophosphatasia:
Prognosis is fair to poor because the genetic disorders alter the way the host responds to bacterial plaque. Necrotizing ulcerative gingivitis- With control of bacterial plaque and secondary factor such as smoking, psychological stress, or poor nutrition, the prognosis for patient with NUG is good. If there is poor control of secondary factors damages can become irreversible and the prognosis may be downgrade to fair. Necrotizing ulcerative Periodontitis- Prognosis depends on alleviating the plaque and secondary factors associated with NUG. In patients that are immunocompromised through systemic conditions such as HIV, prognosis depends on not only reducing local and secondary factors, but dealing with the systemic condition.
Prognosis- A prediction of the probable course, duration, and outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease.
Prognosis is established after diagnosis and before treatment plan.
Types of prognosis:
Excellent prognosis: No bone loss, excellent gingival condition, good patient cooperation, no systemic environmental factors.
Good prognosis: the patient will have one or more of the following: adequate remaining bone support, adequate possibilities to control plaque, adequate patient cooperation, no systemic or environmental factors, and if systemic factors present then well controlled.
Fair prognosis: the patient will have one or more of the following: less than adequate remaining bone support, some tooth mobility, grade I furcation involvement, adequate maintenance possible, acceptable patient cooperation, and presence of limited systemic or environmental factors.
Poor prognosis: the patient will have one or more of the following: moderate to advance bone loss, tooth mobility, grade I or II furcations, difficult to maintain areas, doubtful patient cooperation, and presence of systemic or environmental factors.
Questionable prognosis: the patient will have one or more of the following: advance bone loss, grade II or III furcations, tooth mobility, inaccessible areas, and presence of systemic or environmental factors.
Hopeless prognosis: the patient will have one or more of the following: advance bone loss, non maintainable areas, extractions indicated, and presence of uncontrolled systemic or environmental factors.
Factors in Determination of Prognosis:
Clinical factors include patient age, disease severity, plaque control, and patient compliance.
- Prognosis is dependent on patients attitude, desire to retain their natural teeth, willingness and ability to maintain good oral hygiene because without patient compliance the treatment may not be successful.
Systemic and environmental factors include smoking, systemic disease, genetic factors, and stress.Prognosis is generally better for older patients because in younger patients the periodontal destruction has occurred in a short time period.
- Patients with well controlled diabetes with slight and moderate periodontitis have a good prognosis as long as the patient is compliant.
- When a patient smokes the prognosis is not as favorable to periodontal therapy. A patient that smokes with slight to moderate periodontitis prognosis is fair to poor. In patients with severe periodontitis the prognosis may be poor to hopeless. Smoking cessation is strongly encouraged in patients with periodontitis to have a more favorable prognosis.
- Stress can also have an impact on the prognosis such as physical, emotional, and substance abuse.
Local factors include plaque and calculus, tooth mobility, and subgingival restorations.- Teeth with subgingival restorations can accumulate plaque and may have a poor prognosis compare to teeth with restorations that are supragingival.
Anatomical factors include short roots, cervical enamel projections, enamel pearls, root concavities, developmental grooves, furcation involvement, root proximity and tooth mobility.- Prognosis is poor when the teeth have short tapered roots and relatively large crowns
Prosthetic and restorative factors include caries, nonvital teeth, root resorption, and abutment selection.Prognosis for Patients with Gingival Diseases:
Gingivitis associated with dental plaque only-
The prognosis is good if local factors contributing to plaque retention are removed and if the patient cooperates by maintaining good oral hygiene.
Plaque induced gingival diseases modified by systemic factors-
Long-term prognosis for these patients depends not only on plaque control, but also on the control or correction of the systemic factors.
Plaque-induced gingival diseases modified by medications-
Long-term prognosis depends on whether the patient’s systemic problem can be controlled by an alternative medication that does not have gingival enlargement as a side-effect. If the gingivitis is caused by oral contraceptives the prognosis depends on the control of plaque as well as the likelihood of continuing the use of the oral contraceptive.
Non-Plaque-Induced gingival lesions-
Prognosis for these patients depends on the elimination of the causative agent or the management of the associated dermatological disorder.
Prognosis for Patients with Periodontitis:
Chronic Periodontitis-
In slight to moderate periodontitis the prognosis is usually good, provided that the inflammation is controlled with good oral hygiene and the elimination of plaque retentive factors. In patients with severe disease, furcation involvement, mobility, and are not compliant with hygiene practices the prognosis may be downgraded to fair or poor.
Aggressive Periodontitis-
If diagnosed early, localized aggressive periodontitis can be treated with oral hygiene instruction and systemic antibiotic therapy resulting in an excellent prognosis. In more advanced cases the prognosis can still be good if treated with debridement, local and systemic antibiotics, and regenerative therapy. In patients with generalized aggressive periodontitis, secondary contributing factors such as cigarette smoking are often present. These factors often do not respond well to treatment and therefore have a fair, poor, or questionable prognosis. The use of systemic antibiotics should be considered to help control the disease.
Periodontitis as a manifestation to systemic disease-
Prognosis is fair to poor because the genetic disorders alter the way the host responds to bacterial plaque.Periodontitis associated with hematologic disorders such as leukemia and acquired neutropenias: the prognosis is often fair to poor due to the alteration of the ability of the host to respond to the microbial challenge.
Periodontitis associated with genetic disorders such as familial and cyclic neutropenia, down syndrome, Papillon-Lefevre syndrome, and hypophosphatasia:
Necrotizing ulcerative gingivitis-
With control of bacterial plaque and secondary factor such as smoking, psychological stress, or poor nutrition, the prognosis for patient with NUG is good. If there is poor control of secondary factors damages can become irreversible and the prognosis may be downgrade to fair.
Necrotizing ulcerative Periodontitis-
Prognosis depends on alleviating the plaque and secondary factors associated with NUG. In patients that are immunocompromised through systemic conditions such as HIV, prognosis depends on not only reducing local and secondary factors, but dealing with the systemic condition.